Anterior Segment Imaging for Anterior Chamber Angle Assessment

Objective: To review and update the available methods for evaluating the anterior chamber angle (ACA). Methods: We analyzed and discussed the main findings of selected published articles on ACA assessment and performed a critical review of each method. Results: Gonioscopy is the reference standard examination for evaluation of ACA. Because no other examination technique permits appropriate differentiation between apposition and synechial angle closure, indentation gonioscopy is essential to determine proper clinical management decisions. Imaging techniques such as ultrasound biomicroscopy and anterior segment-optical coherence tomography are useful and promising modalities for ACA assessment; however, ophthalmologists need to look for good-quality images and understand the particularities and inherent limitations of these techniques for proper interpretation of the results. Conclusion: Imaging technologies may represent an important adjunct for the clinical assessment of ACA; however, longitudinal studies should be performed to determine the relative values of their findings in the management of patients with angle closure. Until then, none of these imaging techniques can replace gonioscopy as the reference standard examination.